The purpose of this page is to describe the purpose of the use of the Timed Up and Go (TUG) test in the geriatric population. It also provides information about how to administer the test, cut off values for the test, as well as information about alternate forms of the test.
Objectives:
1. The reader will understand the purpose of using the TUG.
2. The reader will understand the populations in which the TUG can be used.
3. The reader will understand how to appropriately perform the TUG.
4. The reader will learn how to interpret the results of the TUG.
5. The reader will understand the use of alternate forms of the TUG
6. The reader will understand the reliability and validity of the measure.
Purpose of Timed Up and Go:
The purpose of the TUG is to help clinicians assess a patient’s mobility level, balance, walking ability, and fall risk in older adults. There is also a cognitive TUG and a manual TUG discussed later. Some studies have found the TUG is more useful in determining fall risk in elderly adults who are lower functioning and less healthy versus those who are healthy, higher functioning adults. For healthy community dwelling older adults, the cognitive TUG has been proven to be more valid in determining fall risk. These can also be used as a mobility screening tool where the PT can determine gait abnormalities and balance during gait activities. Ultimately this test can be used in rehabilitation clinics to help determine those at risk for falls, so appropriate treatment can be prescribed from the Physical Therapist.
Validated Populations:
Adults over 60 years old (especially frail older adults)
Alzheimer’s Disease
Osteoarthritis
Chronic Stroke
Parkinson’s Disease
SCI
Other populations have been studied, however, these are the ones in which normative data was established.
Supplies needed:
No training is required to administer the TUG. The supplies you will need include a stopwatch, tape or cone for marking distance, a standard height chair (seat height 46 cm, arm height 67 cm), and a measuring tape.
How to Administer:
Mark a line/cone at 3 meters (10 ft) away from the chair. The patient is instructed to sit in the standard arm chair with his/her back against the chair with arms rested on the arm rests. If the patient needs an assistive device they may use one, however, it must be the same one used for each subsequent test. When you say “go” the patient will stand up from the chair, walk to the line 3 meters away at their normal, safe pace, turn around the line/cone, and walk back to the chair and sit down. The person administering the test will start the clock when they say go and stop the clock when the patient is seated again. Be sure to guard the patient while they are walking for safety purposes. During test administration, the physical therapist can note any gait deviations as well as balance issues the patient experiences.
Normative and Cut off Values:
There are many differences between what different studies say about the cut off score for fall risk. According to the CDC’s STEADI program, anyone who has a time of greater or equal to 12 seconds is at risk for falls. Bohannon performed a meta-analysis to determine mean normative scores and found the following:
60-69 years old: 8.1 seconds
70-79 years old: 9.2 seconds
80-99 years old: 11.3 seconds
Rehab measures established a cut off score of > 13.5 seconds for community dwelling older adults. Multiple sources have established multiple cut-off scores.
Alternate forms of the TUG:
Cognitive TUG: add a cognitive task such as counting down by a random number from 20-100 while performing the TUG
o i.e. Can you count down by 7’s from 100?
o Has been shown to be a valid prognostic assessment in determining fall risk for community dwelling elderly adults.
Manual TUG: Carrying a full cup of water while performing the TUG
These tools are used to determine dual task abilities and fall risk.
A cut-off score of 15 seconds is used to determine fall risk for the elderly population.
Reliability/Validity of the TUG:
Inter-rater reliability has been shown to be excellent when administering the TUG. Face validity has not been established, however, there has been excellent concurrent validity of the TUG when compared to the Berg Balance test, gait speed, the Barthel Index, and the functional gait assessment. Schoene et al., however, has found diagnostic accuracy (predictive validity) to be moderate at best. Some studies have found in community dwelling older adults, it only has limited ability to predict falls in community dwelling elderly adults, therefore, should not be used in isolation to determine fall risk in a healthy, community dwelling elderly population. The Cognitive TUG, however, has been shown to be a valid prognostic tool to predict falls in community dwelling older adults.
2. Schoene D, Wu S, Lord S, et al. Discriminative Ability and Predictive Validity of the Timed Up and Go Test in Identifying Older People Who Fall: Systematic Review and Meta-Analysis. Journal Of The American Geriatrics Society [serial online]. February 2013;61(2):202-208. Available from: CINAHL Complete, Ipswich, MA. Accessed June 7, 2017
3. Bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. Journal of Geriatric Physical Therapy. January 2006; 29(2): 64-68.
4. STEADI: Stopping Elderly Accidents, Deaths, and Injuries. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/steadi/pdf/TUG_Test-a.pdf. Accessed June 2, 2017.
5. Barry E, Galvin R, Keogh C, et al. Is the timed up and go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatrics. February 2.0; 14: 14.
6. Hofheinz M, Mibs M. The Prognostic Validity of the Timed Up and Go Test With a Dual Task for Predicting the Risk of Falls in the Elderly. Gerontology and geriatric medicine. 2016;2:2333721416637798. doi:10.1177/2333721416637798.
Objectives:
Purpose of Timed Up and Go:
The purpose of the TUG is to help clinicians assess a patient’s mobility level, balance, walking ability, and fall risk in older adults. There is also a cognitive TUG and a manual TUG discussed later. Some studies have found the TUG is more useful in determining fall risk in elderly adults who are lower functioning and less healthy versus those who are healthy, higher functioning adults. For healthy community dwelling older adults, the cognitive TUG has been proven to be more valid in determining fall risk. These can also be used as a mobility screening tool where the PT can determine gait abnormalities and balance during gait activities. Ultimately this test can be used in rehabilitation clinics to help determine those at risk for falls, so appropriate treatment can be prescribed from the Physical Therapist.
Validated Populations:
- Adults over 60 years old (especially frail older adults)
- Alzheimer’s Disease
- Osteoarthritis
- Chronic Stroke
- Parkinson’s Disease
- SCI
Other populations have been studied, however, these are the ones in which normative data was established.Supplies needed:
No training is required to administer the TUG. The supplies you will need include a stopwatch, tape or cone for marking distance, a standard height chair (seat height 46 cm, arm height 67 cm), and a measuring tape.
How to Administer:
Mark a line/cone at 3 meters (10 ft) away from the chair. The patient is instructed to sit in the standard arm chair with his/her back against the chair with arms rested on the arm rests. If the patient needs an assistive device they may use one, however, it must be the same one used for each subsequent test. When you say “go” the patient will stand up from the chair, walk to the line 3 meters away at their normal, safe pace, turn around the line/cone, and walk back to the chair and sit down. The person administering the test will start the clock when they say go and stop the clock when the patient is seated again. Be sure to guard the patient while they are walking for safety purposes. During test administration, the physical therapist can note any gait deviations as well as balance issues the patient experiences.
Normative and Cut off Values:
There are many differences between what different studies say about the cut off score for fall risk. According to the CDC’s STEADI program, anyone who has a time of greater or equal to 12 seconds is at risk for falls. Bohannon performed a meta-analysis to determine mean normative scores and found the following:
- 60-69 years old: 8.1 seconds
- 70-79 years old: 9.2 seconds
- 80-99 years old: 11.3 seconds
Rehab measures established a cut off score of > 13.5 seconds for community dwelling older adults. Multiple sources have established multiple cut-off scores.Alternate forms of the TUG:
Reliability/Validity of the TUG:
Inter-rater reliability has been shown to be excellent when administering the TUG. Face validity has not been established, however, there has been excellent concurrent validity of the TUG when compared to the Berg Balance test, gait speed, the Barthel Index, and the functional gait assessment. Schoene et al., however, has found diagnostic accuracy (predictive validity) to be moderate at best. Some studies have found in community dwelling older adults, it only has limited ability to predict falls in community dwelling elderly adults, therefore, should not be used in isolation to determine fall risk in a healthy, community dwelling elderly population. The Cognitive TUG, however, has been shown to be a valid prognostic tool to predict falls in community dwelling older adults.
Conclusion:
The timed up and go is useful in predicting falls in the frail elderly adults who have lower mobility. To assess fall risk in the community dwelling older adults, the cognitive TUG is a more appropriate tool.
The link for the CDC STEADI TUG form is referenced below:
https://www.cdc.gov/steadi/pdf/tug_test-a.pdf
Instructions and demonstration for TUG:
http://www.rehabmeasures.org/PDF%20Library/Timed%20Up%20and%20Go%20Test%20Instructions.pdf
https://www.youtube.com/watch?v=BA7Y_oLElGY
More information about the Cognitive and Manual TUG (how to administer and video):
http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1057
https://www.youtube.com/watch?v=X-TONenxHPs
References: